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Access to Nurse Practitioners

Edwidge ThomasThe Affordable Care Act–also known as Obamacare–has extended health insurance coverage to millions of Americans. But access to coverage doesn’t guarantee access to care. With a shortage of primary care providers in the U.S., the Affordable Care Act tries to bump up the numbers of physicians, nurse practitioners and physician assistants who can provide this care. Expanding the numbers isn’t the only approach to improving access to care that can promote the health of people. For example, nurse practitioners face numerous barriers to providing care in affordable, effective, and efficient ways. New York State’s new budget law included language to begin to remove some of these barriers, but the continuing opposition by organized medicine made this effort fall short of authorizing nurse practitioners to practice without mandated collaboration with physicians–something that one-third of states now permit and that the evidence documents is not only safe, but may improve the care that patients receive.

Tonight on Healthstyles, producer Diana Mason, PhD, RN, discusses these issues with Edwidge Thomas, RN, ANP, DNP, and adult nurse practitioner and Director of Clinical Practice Affairs at the NYU College of Nursing. That’s tonight on WBAI, 99.5 FM (www.wbai.org) from 11:00 PM to 11:25. Or click here to listen anytime:


Military Sexual Assault – Male Victims Coming Forward

Justice Denied

Justice Denied

The epidemic of rape in the United States military is not a new issue. The Department of Defense estimates there were a staggering 22,800 violent sex crimes in the military in 2011. 20% of all active-duty female soldiers are sexually assaulted. Female soldiers aged 18 to 21 accounted for more than half of the victims. Now, men are coming forward to share their stories of sexual violence while in the military.

Thursday, April 17th on WBAI 99.5 FM at 11:00 PM tune into Healthstyles when co-host Barbara Glickstein interviews Michael Matthews, USAF Retired disabled veteran who served for 20 years. He is a military sexual trauma (MST) survivor. He is joined by Geri Lynn Weinstein Matthews, MSW LICSW, a licensed clinical and medical social worker with a specialty in trauma. They were subjects in The Invisible War, a documentary about military sexual violence that was nominated for an academy award in 2013.

They have co-produced a documentary, Justice Denied about MST from the Male perspective. You can view the trailer here.

They are committed activists working to end sexual assault within the U.S. military and to help survivors of Military Sexual Assault heal.

You can contact Michael Matthews by telephone at 505-270 2496 if you or anyone you know has been a victim of MST or want to reach out to support their work.

Gerri Lynn Weinstein Matthews can be sent a direct message via her Facebook  page.

You can listen to the interview MST with Matthews

Change the Conversation on Obamacare: From Penalties to Promoting Health

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The March 31st deadline for people to sign up for insurance coverage under the Affordable Care Act (ACA) has come and gone. Media coverage prior to the deadline reached a feverish pitch and no doubt helped the Obama administration to exceed its revised target of 6 million people enrolled under the health insurance exchanges. But it is foolhardy to believe that simply covering more people to receive care in a dysfunctional, acute-care-oriented system will promote the nation’s health and reduce health care costs. Perhaps now we can shift the national conversation to the many components of the ACA that can change how and where we can promote the health of people where they live, work, and play. Health promotion–not insurance penalties–is what the health care system needs more of.

Most people are unaware of the law’s provisions that can change what kind of health care— is delivered–and where and how. For example, “Independence At Home” is an initiative built into the ACA that expands capitated programs for all-inclusive care–physical, psychological, social, and functional–of older adults provided by physician- or nurse-led interprofessional primary care teams. These programs already exist and have been shown to be successful in keeping older adults living in their own homes, out of nursing homes and hospitals, and engaged in health and social activities, with improved quality of life and lower costs.

At the other end of the life spectrum, the ACA expands funding for home visitation programs for high-risk mothers and their newborns, based largely upon the Nurse-Family Partnership (NFP). The NFP has decades of research documenting the short- and long-term benefits to the physical, psychological, and social health of participating women and their children, with a significant return on investment–a $5.70 return for every dollar invested in a high-risk family.

Demonstration projects are already under way to expand models of transitional care that help patients and their family caregivers better manage their acute and chronic illnesses in ways that reduce 30-day hospital readmissions. The focus on reducing the rate of readmissions has already moved most hospitals to test new ways of partnering with community-based health care organizations to smooth the transition from hospital to home.

The ACA also includes grants for employee wellness programs. Initiatives such as Wise Health Decisions, a nurse-led employee wellness program in Indiana that contracts with employers to provide on-site health promotion and coaching services, have demonstrated improved health indicators while reducing employers’ spending on health care. The investment in health promotion enables health risk assessments, early detection of health problems, and helping people become more engaged in living healthier lives.

Two other elements of the ACA have great potential for promoting the health of communities: the community benefit requirement for nonprofit hospitals and the expansion of nurse-managed health centers. The former requires nonprofit hospitals to conduct a health needs assessment of a community they serve, develop a community improvement plan, and demonstrate how they are helping to implement this plan–ideally, in partnership with the local public health department and other community stakeholders. Some hospital executives view this requirement cynically as simply more paperwork to keep their nonprofit tax status. But it’s an opportunity to engage one of the most powerful employers in a community to be vested in a healthy future. We may need to put some teeth into this requirement by developing value-based payments for hospitals that can show meaningful engagement and progress on community improvement plans.

Finally, the ACA authorized nurse-managed health centers (NMHCs), but did not mandate funding them. Most NMHCs were started by schools of nursing through funding from the U.S. Health Resources and Services Administration to create clinical practices that serve the needs of vulnerable and underserved populations and to provide sites for faculty practice and clinical teaching of students. Today, there are about 150 NMHCs, some of which are federally qualified health centers. Most are served by interprofessional teams of nurses, physicians, nutritionists, social workers, and others to provide primary care and wellness services to individuals, families, and the whole community. For example, the Eleventh Street Family Health Service in North Philadelphia recognized that the leading health problems in the community it serves are obesity, diabetes, hypertension, and heart failure. In addition to individual and group health services to address these problems, the clinic organized a local farmer’s market on site and created a community garden that is tended by the neighborhood youth as ways to bring healthy eating into this community, which had no supermarket before 2011.

Meeting the “triple aim” of improving people’s experiences with health care, improving the health of the population, and reducing per capita health care costs requires more than improving access to coverage. The ACA provides opportunities to test, refine, and expand models of care that can reduce the need for acute care. But it’s only a beginning. Many of these models should be available to communities across the nation, instead of being an uncommon experience. It’s time to change the conversation away from insurance coverage and penalties and toward program investments that truly matter if we’re to become a healthier nation.

Diana J. Mason is the Rudin Professor of Nursing at Hunter College, a member of the doctoral faculty at the Graduate Center, CUNY and President of the American Academy of Nursing. Donna Nickitas is a professor of nursing at Hunter College and the executive officer of the nursing doctoral faculty at the Graduate Center, CUNY.

Prison Baby by Deborah Jiang Stein

PrisonBaby-GloriaSteinem-copy

Everyone has a story. Deborah Jiang Stein‘s adoptive parents didn’t want her to know that she was born in prison to a heroin-addicted mother. 

Tune in on Thursday, April 10 to Healthstyles on WBAI 99.5 FM Pacifica Radio at 11:00 PM guest Deborah Jiang Stein, author of the memoir, Prison Baby published by Beacon Press, advocate for incarcerated women and the founder of the unPrison Project is interviewed by co-host Barbara Glickstein.  Themes of disconnection, secrets, transracial adoption, incarceration of women and babies born in prison are discussed. 

Find out more about the unPrison Project and consider supporting the Behind Books Not Bars Prison Baby book club for incarcerated women and girls.

Listen to the interview 


Why Nurses Need A Google Doodle

National Nurses Day is less than a month away, and I’m not excited about it. I’ve received one too many “Code Brown Queen” cards in the span of my career. More frequently celebrated with cheesy, tongue-in-cheek gifts than genuine recognition of the achievement, skill and accomplishments of its 3.1 million members, this nurse wonders if it isn’t time to change things up on May 6th.

I don’t know about you, but I’ll pass on the joke-y cards, magnets and sweatshirts. I don’t need the swag or even the extra attention; I’m just doing the job I feel called to, after all. But since the holiday exists, I think we should use it as an opportunity to actually further the visibility of the nursing profession in a proactive and intelligent manner.

So, this year, I’m asking for the Nurses Week gift I actually want: Nurses and their supporters to demand a National Nurses Day Google Doodle. 

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Maybe, if the millions of Americans Googling something on May 6th saw a tribute to modern day nursing, we’d be able to start a conversation about our profession that’s long overdue. 

The Google Doodle team calls for suggestions that “celebrate interesting events and anniversaries that reflect Google’s personality and love for innovation.” Nursing was founded on the laurels of individuals who changed the course of medicine, and continues on the backs of nurses who daily care for and protect millions of lives through creative troubleshooting, critical thinking, and fast-paced decisions. Florence Nightingale practically discovered germ theory, most modern-day hospital procedure is based on nursing research, and any nurse who has worked short-staffed, survived the shift by relying on innovation.

So why hasn’t Google celebrated us since they started doodling 14 years ago? (To be fair, they did a small, somewhat belittling doodle for Nightingale’s birthday in 2008). 

I don’t blame Google for neglecting us every year, exactly. The trouble with us nurses, is we don’t talk about what we do. Our creativity and guile and innovative genius lays locked within the halls of our practice. The tiny work-arounds we find and share with each other at the bedside change lives, but are rarely known by anyone but nurses, much less understood publicly. Nursing research, although utilized in almost every existing medical decision and implemented at the Federal level, is often poo-pooed as a soft science. And for some reason, we can’t manage to break into Hollywood as anything but drug abusers or tyrants. We’re largely missing from policy debates, few of us have paced the floors of Congress, and the pages of our newspapers are void of our heroic stories and focused opinions. It’s time we start sharing what we do in a way that those we serve can understand.

With our foundations and our future in mind, I think nurses – all 3.1 million of us – as American innovators, need a shout out from Google, the portal of the universe, this National Nurses Day. Maybe, when we’re showcased on the most innovative website on the internet, our country will realize how much we deserve to be there, and we will start actively telling them why.   

So, here’s my plan: Starting this Sunday, I’ve e-mailed the Google Doodlers a suggestion for a doodle celebrating modern-day, living American nurses, calling attention to our innate innovative spirit. In each e-mail, I’m showcasing a living nurse innovator. Sunday, I wrote about Cathy Papia, a nurse from my hometown of Buffalo, who started the White Wreath Protocol, a simple way to alleviate the suffering that comes along with dying in an ICU when a hospice unit is unavailable. Monday, I told the doodlers about Mary Wakefield, the Obama-appointed administrator of the HRSA. Yesterday, doodlers got a briefing on the profoundly innovative contribution of UCSF’s Living Legend, Patricia Benner, and today, I reminded them of Carol Gino, whose voice has peppered the profession with innovative narrative for decades.

Tune in, and share: I’m posting the e-mails I send to the Google Doodle team on my blog, This Nurse Wonders, and I’ll re-hash here, on the Facebook page, Why Nurses Need A Google Doodle, and via @12HourRN.

Nurses are amazing, multi-faceted clinicians, inventors, policy makers, artists, problem-solvers and care-givers. Long before Google became a verb, “nurse” entered the language of the globe and changed it forever. We’re still here to tell our tales; perhaps Google will give us a boost.

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